presented by: total health care totally there for you coding for diabetes mellitus 1

1

Presented by:

Total Health Care

Totally There For You

Totally There For You

CODING FOR DIABETES MELLITUS

Totally There For You 2

Gain an understanding of billing ICD-9-CM codes, specific to Diabetes Mellitus

OBJECTIVE


This presentation will focus on ICD-9-CM codes

ICD-10-CM will be effective 10/1/2015

ICD-9-CM AND ICD-10-CM


Coders/health care providers can assign ICD-9-CM codes based on what is documented in the chart

DOCUMENTATION AND ICD-9-CM CODING


250.00-250.93: Most common. 40 codes in this range. Requires 5 digits.

249.0X-249.9x: DM due to secondary cause

648.XX: Gestational DM

THREE CODE RANGES FOR DM


Will be the focus of education

250 represents DM

250.X - The 4 t h space indicates the complication or not. 250.1 is Diabetes with Ketoacidosis; 250.0 means DM without mention of complication

250.XX SERIES. BASE CODE AND 4TH DIGIT


The subclassifications are as follows: 0 -type 2 or unspecified, not stated as uncontrolled 1-type 1, not stated as uncontrolled 2-type 2 or unspecified, uncontrolled 3-type 1, uncontrolled

250.XX – The 5 t h digit indicates the type (1 or 2) and whether it is controlled or uncontrolled. 250.10 – Diabetes with Ketoacidosis, type 2 or unspecified, not stated as uncontrolled; 250.01 – DM w/o mention of complication, type 1, not stated as uncontrolled; 250.53- DM with ophthalmic manifestations, type 1, uncontrolled

250.XX 5TH DIGIT


If the type of DM is not documented in the medical record, the default is type 2

All type 1 pts. use insulin, so therefore there is no need to code the long term insulin use, i t is assumed they are on the medication

Some patients use insulin for type 2 as well. If the documentation does not indicate the type of DM but does indicate insulin use, the appropriate 5 t h digit for type 2 must be used

Routine (long term) insulin use is coded using V58.67 in addition to the 250.XX code, when appropriate, for type 2 or non-indicated type of DM

ADDITIONAL CODING RULES FOR DM


When assigning codes for DM and its associated conditions 250.XX is sequenced first The associated conditions are coded second

Example:

Practitioner documents the il lness as DM, on insulin, with CKD, stage 3 secondary to DM. Codes as follows:

250.40-DM with renal manifestations, type 2 or not specified, not stated as uncontrolled

585.3-CKD stage 3 V58.67 – long term use of insulin*

* Long tem insulin coded in this instance because note does not indicate type of DM, so coding rules assume type 2

SEQUENCING DM CODES


Note lists assessment as DM, type 1, uncontrolled, taking insulin regularly

250.03 –DM w/o mention of complication, type 1 uncontrolled

No V code for long term insulin use as it is assumed type 1 DM patients take insulin

Assessment indicates DM, uncontrolled with gangrene L great toe. Continues to take Novalog as ordered. 250.72-DM with peripheral circulatory disorders, type unspecified,

uncontrolled 785.4-Gangrene V58.67 – Long term insulin use

PRACTICE CODING


Observation says: A1C’s running between 10 and 11.4; Blood sugar log reviewed. Taking insulin as prescribed.

Assessment: DM, type 1.

Codes to:

250.01 DM, type 1, not stated as uncontrolled*

*Not able to code to uncontrolled as assessment did not indicate an uncontrolled il lness

PRACTICE CODING CONTINUED


Assessment indicates DM, uncontrolled Code to 250.02 - DM, unspecified type, uncontrolled

Assessment indicates Diabetes Mellitus Codes to 250.00 – DM w/o mention of complication, type not

specified, not stated as uncontrolled

MORE PRACTICE CODING


Underdose of insulin due to pump failure is assigned 966.57-mechanical complication due to insulin pump and is listed FIRST followed by the appropriate DM code, based on the documentation

Overdose of insulin is also reported using the same code 966.57 first, then 962.3 poisoning by insulins and antidiabetic agents, followed by the appropriate DM code, based on the documentation

INSULIN PUMP MALFUNCTIONS


E08-E13 Range

E08- due to underlying condition E09- drug or chemical induced E10 –Type 1 E11- Type 2 There is no E12 E13 – other specified DM

A PEEK INTO ICD-10-CM DM CODES


If type of DM is not documented- code default is E11

If type not indicated but insulin use is documented, default remains E11 with additional code of Z79.4 (long term insulin use)

The complication/comorbid condition is in the code for ICD-10-CM

Suggest practicing specific documentation of DM, Type and Complication if relevant

MORE ICD-10-CM INFORMATION


Coding is based on the documentation in the note

Coding will be as accurate as the assessment documented

Be specific with your documentation

Long term insulin use does not need to be reported when documentation indicates a type 1 diabetic

SUMMARY


QUESTIONS?


Michelle Solomon

Data Analytics and Provider Education Manager

Total Health Care, Inc.

3011 W Grand Blvd, Suite 1600

Detroit, MI 48202

Office: 313-871-6587

Cell: 313 300-2852

Fax: 586-461-2538

[email protected]

THANK YOU

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presented by: total health care totally there for you coding for diabetes mellitus 1

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